Using Quality Improvement to Reduce Continuous Pulse Oximetry Use in Children With Wheezing

Schondelmeyer, Amanda C.; Simmons, Jeffrey M.; Statile, Angela; Hofacer, Kelsey E.; Smith, Robert E.; Prine, Lori; Brady, Patrick

doi:10.1542/peds.2014-2295

Cited by 41 publications

(46 citation statements)

References 30 publications

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“…Statistical process control (SPC) p-charts and run charts were used to monitor changes in hospital SSPs using established rules for identifying special cause variation. 17,18 We considered 8 consecutive points above or below the centerline and any points outside the control limits to represent special cause variation and prompt a change in the centerline. 19,20 Such observations happen <0.4% of the time by chance and are therefore conventionally accepted as suggesting statistically significant changes.…”

Section: Discussionmentioning

confidence: 99%

Improving Safe Sleep Practices for Hospitalized Infants

et al. 2016

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BACKGROUND AND OBJECTIVES: Adherence to the American Academy of Pediatrics safe sleep practice (SSP) recommendations among hospitalized infants is unknown, but is assumed to be low. This quality improvement study aimed to increase adherence to SSPs for infants admitted to a children’s hospital general care unit between October 2013 and December 2014. METHODS: After development of a hospital policy and redesign of room setup processes, a multidisciplinary team developed intervention strategies based on root cause analysis and implemented changes using iterative Plan–Do–Study–Act cycles. Nurse knowledge was assessed before and after education. SSPs were measured continuously with room audits during sleeping episodes. Statistical process control and run charts identified improvements and sustainability in hospital SSPs. Caregiver home practices after discharge were assessed via structured questionnaires before and after intervention. RESULTS: Nursing knowledge of SSPs increased significantly for each item (P ≤ .001) except avoidance of bed sharing. Audits were completed for 316 sleep episodes. Simultaneous adherence to all SSP recommendations improved significantly from 0% to 26.9% after intervention. Significant improvements were noted in individual practices, including maintaining a flat, empty crib, with an appropriately bundled infant. The largest gains were noted in the proportion of empty cribs (from 3.4% to 60.3% after intervention, P < .001). Improvements in caregiver home practices after discharge were not statistically significant. CONCLUSIONS: Sustained improvements in hospital SSPs were achieved through this quality improvement initiative, with opportunity for continued improvement. Nurse knowledge increased during the intervention. It is uncertain whether these findings translate to changes in caregiver home practices after discharge.

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Section: Discussionmentioning

confidence: 99%

Improving Safe Sleep Practices for Hospitalized Infants

et al. 2016

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“…Currently, efforts are made to reduce what is perceived as unnecessary monitoring with pulse oximetry. 16 It is a key problem that funding of formal testing of clinical benefit is not economically feasible for the industry and not required for approval of medical devices for clinical use.…”

Section: What Is To Be Done?mentioning

confidence: 99%

Cerebral oximetry in preterm infants: an agenda for research with a clear clinical goal

et al. 2016

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Abstract. Preterm birth constitutes a major cause of death before 5 years of age and it is a major cause of neurodevelopmental impairment across the world. Preterm infants are most unstable during the transition between fetal and newborn life during the first days of life and most brain damage occurs in this period. The brain of the preterm infant is accessible for tissue oximetry by near-infrared spectroscopy. Cerebral oximetry has the potential to improve the long-term outcome by helping to tailor the support of respiration and circulation to the individual infant's needs, but the evidence is still lacking. The goals for research include testing the benefit and harms of cerebral oximetry in large-scale randomized trials, improved definition of the hypoxic threshold, better understanding the effects of intensive care on cerebral oxygenation, as well as improved precision of oximeters and calibration among devices or standardization of values in the hypoxic range. These goals can be pursued in parallel. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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“…5 Our other general pediatric unit served as a control during the QI project. Our outcome measure was the time on CPOx after meeting predefined goals (eg, oxygen saturations on room air .90% for 2 hours or weaned to every 2-hour albuterol treatments).…”

Section: Methods Settingmentioning

confidence: 99%

“…4 Pursuant to this, we performed a quality improvement (QI) project that reduced clinically unnecessary CPOx monitoring for pediatric patients with wheezing (ie, asthma, bronchiolitis, and wheezing-associated respiratory infection) by .70% on a single unit. 5 Alarm fatigue has been highlighted as a common contributing cause to serious in-hospital morbidity and mortality as health care workers become desensitized to alarms, leading to delayed or absent response to critical patient events. 6 Despite studies suggesting questioning the effect of continuous monitoring on general hospital units, 7 and recommendations from multiple organizations to reduce CPOx use, its effect on overall physiologic monitor alarm frequency on a general pediatric ward has not been quantified.…”

mentioning

confidence: 99%